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‘Time to reengineer the system’: PDA pushes for two-pharmacist model

Community pharmacies should implement a new model under which two pharmacists work alongside one another to provide different healthcare interventions, the Pharmacists’ Defence Association (PDA) has suggested. 

The COVID-19 pandemic has proven that the “time to re-engineer the system to not only improve the patient journey, but also to use limited NHS resources to much better effect has surely arrived”, the union wrote in a report looking at opportunities for post-COVID-19 pharmaceutical care.

The report, published this morning (August 12), sets out 11 “post COVID-19” proposals, which aim to “break down the historical silo approach that has always been taken by policymakers to healthcare delivery”.

One key suggestion, based on a two-pharmacist model, would see a “clinic pharmacist” and a patient-facing one working side by side within the same pharmacy.

Read more: PDA chair Mark Koziol on making pharmacy supervision fit for purpose

Under the proposal, the “front-of-counter” patient-facing pharmacist could carry out “vital interventions” opportunistically when patients visit the pharmacy to pick up their prescription. Meanwhile, the second pharmacist – or “clinic pharmacist” – would work “to provide the longer-term pharmaceutical care of registered patients, those referred by GPs”.

Such a model would need to “rely on collaboration” but it would free up GPs’ time to focus on patients with more acute conditions, as well as reducing A&E visits and hospital admissions, the PDA argued.


Pharmacist-led community vaccination hubs


Under the proposals, pharmacist-led vaccination hubs in the community should also “continue to be operated”, the PDA advised.

The COVID-19 crisis led to pharmacy-led vaccination hubs in local communities, the union pointed out.

“This meant that pharmacists could dramatically scale up their service, enabling them to play such a very significant part in the successful delivery of the vaccination programme in England and Wales”.

Pharmacy-led hubs each represent “a healthcare facility in its own right”, the union added, with the “possibility of reaching many millions of people with health improvement and prevention initiatives”.

These initiatives could include health checks, diagnostic checks, and ordering blood monitoring for patients who have not had their bloods analysed, it suggested.

Read more: The award-winning pharmacist revolutionising cancer care

“By using such an opportunity for wider effect, pharmacists could contribute to the reduction of the long waiting list of outstanding diagnostic tests and other urgent procedures where the NHS has latent need,” the PDA explained.

But diagnostic activities should not be restricted solely to pharmacist-led vaccination hubs, the union advised.

In June, NHS England and NHS Improvement unveiled plans for a community pharmacy cancer diagnosis pilot, to allow pharmacy teams to directly refer patients to specialists for scans and checks without having to see a GP.

There are now “opportunities to develop a range of diagnostic testing services in a community pharmacy setting to help manage capacity in other parts of the system, particularly in other parts of primary care”, the PDA said.

This could involve pharmacists assessing the suitability of patients for treatments through pharmacogenomics screening, it suggested.


What are the other recommendations?


Other notable recommendations include allowing pharmacists to make community nursing referrals, increasing access to the NHS for the digitally disenfranchised, supporting the national obesity strategy and ensuring each pharmacy employs one specifically trained social care champion.

According to the proposals, introducing a simplified hospital discharge process – by permitting the electronic prescribing and medicines administration systems to request for medication to be dispensed from a convenient community pharmacy – will “smooth out any unnecessary delays and free up bed occupancy”.

Read more: Suspend CPCS, overhaul commissioning – what sector bodies want from Sajid Javid’s pharmacy reforms

Pharmacists should also be allowed to provide joined-up care through a ‘community of practice’ delivered by a locally managed system, the union recommended.

The creation of a community of practice "can provide wider and much more comprehensive benefits to patients than would be provided by any sole individual healthcare provider working in a silo”, the PDA said.

In June, the then health secretary Sajid Javid revealed government plans to overhaul primary care, “starting with pharmacy”. However, no details of those plans were forthcoming.

Later that month, health minister Maria Caulfield revealed to C+D that announcements on this reform were “weeks away rather than months”.

However, the DH was unable to share an update on this planned reform when approached by C+D earlier this week (August 10).


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